Leprosy Outbreak in Florida Could Reach Endemic Status

Cases of leprosy, a chronic infectious disease, are rising in Florida, as the illness appears to spread locally, according to a recent case report from the Centers for Disease Control and Prevention (CDC).

Leprosy, also known as Hansen’s disease, is caused by a bacteria called Mycobacterium leprae, which primarily attacks the skin and the peripheral nervous system.

Although leprosy is historically an uncommon disease in the United States, the number of reported cases has more than doubled in the southeastern states over the last decade.

According to the National Hansen’s Disease Program, 159 new cases were reported in the U.S. in 2020. The leprosy outbreak in Florida was among the five states with the most reported cases, followed by California, Louisiana, Hawaii, and New York.

Central Florida, in particular, accounted for 81% of cases reported in the state and almost one-fifth of nationally reported cases.

"Historically, the majority of patients in the U.S. with leprosy lived or worked outside the country in disease-endemic areas and acquired their disease abroad or had prolonged contact with immigrants from leprosy-endemic countries; however, more recently, about 1/3 of people with leprosy in the U.S. seem to have locally acquired the disease," says Carrie Kovarik, M.D., FAAD, professor of Dermatology and Medicine at Perelman School of Medicine at the University of Pennsylvania.

Many unrelated cases in the southern states were found to carry the same unique strain of M. leprae as nine-banded armadillos in the region, suggesting that people likely contracted the disease from animals. However, several leprosy cases in central Florida demonstrate no clear evidence of zoonotic exposure or traditionally known risk factors.

"We report a case of lepromatous leprosy in central Florida in a man without risk factors for known transmission routes. We also review the mounting epidemiologic evidence supporting leprosy as an endemic process in the southeastern United States," the CDC report reads.

According to the CDC, the disease is considered endemic when there is a constant amount of that specific disease present in a geographic location, like a state or country. And the leprosy outbreak in Florida is certainly headed in that direction.

Leprosy can affect the skin, eyes, and lining of the nose. The bacteria also attack the nerves, making them swell under the skin. This can cause the affected areas to lose the ability to sense touch and pain, resulting in multiple injuries.

If left untreated, the nerve damage can result in paralysis of the hands and feet. In most severe cases, leprosy may cause apparent loss of toes and fingers, blindness, loss of eyebrows, and saddle-nose deformity.

It may take up to 20 years to develop signs of the infection after exposure to M. leprae.

The skin symptoms of leprosy may include:

  • Discolored patches of skin, usually flat
  • Growths (nodules) on the skin
  • Thick, stiff, or dry skin
  • Painless ulcers on the soles of feet
  • Painless swelling or lumps on the face or earlobes
  • Loss of eyebrows or eyelashes

Kovarik says, "Leprosy presents on a spectrum, from just one to two pink or light colored patches on the skin to 20 patches, or the entire skin being affected. Those affected can experience loss of sweating or numbness in the skin patches. If you are worried, see a board-certified dermatologist so that they can evaluate your skin and perform an appropriate work up."

The symptoms of leprosy nerve damage are the following:

  • Numbness of affected areas of the skin
  • Muscle weakness or paralysis, especially in the hands and feet
  • Enlarged nerves around the elbow and knee and in the sides of the neck
  • Eye problems

Leprosy is treated with a combination of two or three antibiotics — dapsone, rifampin, and clofazimine —and can be cured if treatment is completed as prescribed. Kovarik explains that treatment lasts one to two years, depending on the type of leprosy.

"In order to reduce your risk of leprosy, make sure you or your loved ones are evaluated by a board-certified dermatologist if you see any worrisome or suspicious skin lesions," advises Kovarik. "Also, avoid contact with armadillos or working outside in areas where armadillos reside. If someone you know is diagnosed with leprosy, make sure they are treated fully."

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